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VA Disability Rating for Knee Replacement Surgeries

VA Disability Rating for Knee Replacement Surgeries

During their time in the service, Veterans are exposed to situations that put them at risk. Some injured Veterans only experience short-term effects. Others experience lifelong consequences that entitle them to receive benefits from the Department of Veterans Affairs.

For Veterans who experience knee pain and injuries in the line of duty, knee replacement surgery may eventually be necessary. To cover some of the costs of treatment and living expenses, the VA provides benefits for Veterans who file a successful claim for this disability.

Below, we’ll break down the VA rating process for knee pain and knee replacements. We’ll also tell you what you need to know about making an effective claim for this condition.

What Causes Knee Pain?

Being in the military can put a physical toll on one’s body. The wear and tear can cause the knee to give out over time, especially if proper precautions are not taken.

Combat can also injure a Veteran’s knee in the form of enemy fire, shrapnel from bombs, or other direct contact.

In non-combat situations, Veterans will often overlook pain because they think they have to power through it. However, this can prevent a Veteran from getting the treatment they need. It also could prevent them from documenting key evidence they’ll need when they make a claim through the VA. 

If Veterans feel pain in their knee or experience an event that can cause knee issues during their time in the military, they should report it to an official immediately. This will ensure that the event is documented, which they can use for future VA disability claims.

Strong evidence is usually the deciding factor in whether or not the VA will accept a Veteran’s claim for knee pain and injuries. Without clear documentation, it’s likely that the claim will be denied and the Veteran’s overall disability rating will be affected, reducing the benefits they can receive.

What Makes Knee Replacement Surgeries Necessary?

For Veterans experiencing certain knee conditions or severe pain, surgery may be the best treatment. If the knee injury or condition hasn’t responded to medication, physical therapy, or other treatment options, a total or partial knee replacement may be necessary.

Some common conditions that may require a knee replacement include:

  • Knee injuries
  • Arthritis (both osteoarthritis, rheumatoid arthritis, and gout)
  • Cartilage loss
  • Unusual bone growth

Total knee replacements can be very successful, but partial knee replacements may be a better option for some Veterans. If the knee pain or injury is affecting only one of the knee’s three major components — the medial compartment,  lateral compartment, and patellofemoral compartment — then a partial or “unicondylar” knee replacement will be less invasive.

Either way, Veterans who require knee replacement surgery due to an injury or condition sustained in the line of service will be eligible for VA disability benefits. Below, we’ll break down the ratings you may receive for knee pain and knee replacements.

What Are the VA Ratings for Knee Conditions?

Because many Veterans experience knee pain, the VA sees countless claims regarding knee pain. Unfortunately, this means that the VA can easily overlook crucial information

Many Veterans have debilitating knee pain that affects their work and personal life. However, they may be confused when they see that their disability rating is only 10%.

One thing on the Veteran’s side is that they can have multiple knee problems but still have the VA evaluate each separately. This is usually not allowed for other disabilities.

If a Veteran has pain in their knee, the VA will evaluate each part of the problem separately, ensuring that the Veteran gets the best overall rating possible. The VA will rate a Veteran’s knee depending on how much it can extend, which usually results in a rating between 0% and 50%.

Ratings for Knee Replacements

After a total knee replacement surgery, a Veteran will receive a temporary 100% disability rating for four months. This 100% rating can be extended if the Veteran is still not able to return to work and normal daily activities after four months.

The Veteran may also receive a 60% disability rating after the 100% temporary rating has expired if they continue to experience severe painful motion or weakness in the knee.

Getting the Highest Rating

Veterans who have a disability should seek the highest disability rating they can. This is important. The VA will often give a Veteran a lower rating than they deserve, leading to a loss of benefits.

It can be difficult to get a high rating from the VA due to mistakes within the claims process. However, there are some ways that a Veteran can get the most out of their claim. If a Veteran has other service-connected disabilities in addition to their knee pain or knee replacement, they will likely get a higher rating.

The VA will account for every service-connected disability and give the Veteran a cumulative rating that depends on the disability’s severity.

How Do I Start the Process?

To start receiving disability benefits for knee pain or a knee replacement, the Veteran will have to show evidence in three categories:

  • A current diagnosis
  • Evidence of an in-service stressor
  • A medical report that connects the current diagnosis and in-service stressors

If any of these three components are missing from the claim, the VA will deny it.

Once the VA has reviewed the claim, they will usually send the Veteran to a Compensation and Pension (C&P) exam. Veterans must attend their C&P exam. If they do not, the VA will deny their claim.

The C&P exam ultimately determines whether a Veteran is eligible for benefits. They will go through the evidence that a Veteran provided in their claim, write up a report, and medically examine the Veteran.

Veterans who have a conflict in their schedule with the C&P exam should contact the VA ahead of time. Usually, they can reschedule the exam so that the Veteran can attend the exam.

For knee replacement surgeries, the Veteran will receive a 100% temporary disability rating. For knee pain without a replacement surgery, however, the Veteran will need at least a 10% rating to be eligible for benefits. If the Veteran gets a 0% rating, the VA does not think the disability is severe enough to qualify for benefits.

Can I Get Knee Pain as a Secondary Condition?

In a word, yes. If your knee pain was caused or exacerbated by a primary service-connected condition, you are eligible to make a claim for it as a secondary condition.

Secondary conditions will raise your disability rating and offer more benefits, so it’s important to know the two categories.

The first category is conditions the VA recognizes as caused by an existing service-connected condition. This means that the secondary condition wouldn’t exist if the primary condition didn’t occur.

The second category is conditions that existed before a Veteran entered the service. If the Veteran’s time in the service aggravated or worsened this pre-existing condition, then the Veteran will be able to get benefits for it.

Veterans should not overlook secondary conditions. Often, a single disability rating is not sufficient to cover costs for treatment and related needs. Secondary conditions offer a way for Veterans to receive a higher disability rating to receive more benefits.

Do Benefits for Knee Pain Ever Decrease?

Sadly, knee pain does not usually improve over time. Most doctors will consider a Veteran’s knee pain chronic. Even the best treatment usually only helps decrease the severity of the symptoms rather than healing the problem.

Still, the VA can decrease a Veteran’s rating for knee pain over time — even if it follows a partial or total knee replacement surgery. After a few years, they may presume that a Veteran’s knee condition has improved or healed over time.

To avoid a reduction in their disability rating, Veterans will have to indicate to the VA that they are continuing treatment for their knee. This can include showing that they are still attending physical therapy or that they are still taking medication for their knee pain.

Conclusion

Veterans in need of treatment for knee problems related to their time in the service should make a disability benefits claim through the VA.

Because the VA treats knee claims differently than other disabilities, a Veteran may be able to get a higher disability rating. If a partial or total knee replacement is required, the Veteran will receive a temporary 100% disability rating for four months.

For ongoing knee pain, it is important to continually inform the VA that you are seeking treatment so that your rating does not decrease. If it does, you will need to appeal the VA’s decision to keep your benefits.

Concerned about the complexity of the claims and appeals process? You may benefit from having an experienced Veterans law attorney on your side. Whether you’re trying to claim knee pain as a secondary condition or recovering from a knee replacement surgery, Berry Law is on your side to help you get the benefits you deserve.

Check out the current VA Disability Pay Charts and contact us today for a free evaluation of your case. Contact us today for a free evaluation of your case. Or, for more information on VA law and Veteran’s benefits for knee conditions, visit our website.

Sources:

Partial vs. Total Knee Replacement Surgery | VeryWell Health 

38 CFR § 4.71a — Schedule of Ratings — Musculoskeletal System | Cornell Law School Legal Information Institute 

Types of VA Disability Claims and When To File | Veterans Affairs 

About VA Disability Ratings | Veterans Affairs 

VA Claim Exam (C&P Exam) | Veterans Affairs 

Berry Law

The attorneys at Berry Law are dedicated to helping injured Veterans. With extensive experience working with VA disability claims, Berry Law can help you with your disability appeals.

This material is for informational purposes only. It does not create an attorney-client relationship between the Firm and the reader, and does not constitute legal advice. Legal advice must be tailored to the specific circumstances of each case, and the contents of this blog are not a substitute for legal counsel.

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